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S1544: Comparison of Standard Definition White Light (SD-WL), High Definition White Light (HD-WL), and Narrow Band Imaging (NBI) Colonoscopy: Impact on Surveillance Interval Recommendations
Abstracts in ascending and 1 in transverse colon. All 3 polyps were independently detected on colonoscopy and excised. Histologically all 3 were CRC. MRC failed to detect a 3mm CRC in transverse colon of another patient found on CC. The CRC prevalence in our series was 13%. CC detected a further 30 polyps in 11 patients, 28 of which were ⬍6mm and 2 were 6-10mm. Of the 30 small polyps, 2 were tubulovillous adenomas, 1 sessile serrated adenoma, 17 hyperplastic polyps, and 10 normal mucosa. CC had a false positive rate of 32% as defined by histology. 87% of small polyps excised at CC were not adenoma and had no malignant potential. MRC failed to detect any polyp ⬍10mm. No significant extra-colonic pathology was detected on MRC. Mean patient discomfort score for MRC (20%) was less than that for CC (68%), p⫽0.003. Mean patient inconvenience score for MRC (54%) was comparable to that for CC (52%), p⫽0.931.In this study, MRC was reliable in detecting large polyps, which have potential to be CRC. However MRC currently has poor sensitivity in detecting small polyps, limiting its utility in adenoma screening in high-risk populations at this time. MRC provides better localisation information than CC and has the potential to detect extra-colonic HNPCC-associated cancers. MRC was associated with less discomfort than CC.
respective imaging modality. Polyp size, morphology, and location were documented and polyps were removed and submitted for histopathology. The primary outcomes of this study (prevalence of adenomas) are reported separately. Current results were computed by conducting a post hoc analysis using Fisher’s exact test.Results: 630 patients were enrolled (210 in each arm, mean age of 61 years, 65% male, 72% Caucasian, 66% screening colonoscopies). There were no significant differences in gender, race, quality of bowel prep, or number of screening procedures between the 3 groups. Mean age was higher in the HD-WL arm (62 years) compared to SD-WL (60 years) and NBI (60 years) {p⫽0.001}. Mean withdrawal time was higher for NBI (7.5 min) compared to SDWL (6.9 min) and HD-WL (6.6 min) {p⫽0.0002}. The proportion of patients with 3 or more adenomas, an adenoma ⱖ 1cm, an adenoma with villous features or HGD, and impact on future surveillance interval of 3 years are shown in the table. Conclusion: HD-WL and NBI led to changes in surveillance intervals in 4-5% additional patients over SD-WL. While the impact was not statistically significant, the study was not powered for this endpoints. Additional larger studies are needed to investigate the impact of HD-WL and NBI colonoscopy on this clinically important outcome.
S1543 Simultaneous Evaluation of the Pit and Capillary Patterns of Colorectal Lesions on Routine Colonoscopy - Prime Time for Optical Biopsy Claudio R. Teixeira, Ronaldo J. Torresini, Erica Tozawa, Mauro Maia
3 or more adenomas Adenoma ⱖ 1 cm Adenoma with villous or HGD 3 year follow-up
SD-WL (nⴝ210) HD-WL (nⴝ210) NBI (nⴝ210) p value
The endoscopic in vivo observation of microscopic superficial details of colorectal lesions is now possible. The differential diagnosis of small colorectal polyps and characterization of neoplastic lesions is crucial for a better screening colonoscopy and in choosing the right therapy for each colorectal lesion. Kudo et al. have proposed the pit pattern classification of colorectal lesions. Last year, we have developed an original endoscopic classification of the capillary pattern of colorectal lesions and reported its high accuracy rate in the diagnosis of colorectal lesions (GIE 2009). Both pit and capillary classifications include the normal mucosa, hyperplasia, tubular and villous adenoma and carcinoma in a respective scale from I trough V subtypes. Therefore it is easy and practical to simultaneously determine the pit and capillary patterns of lesions diagnosed on colonoscopy. The aim of our study is to compare the histopathologic findings with the simultaneous endoscopic classification of the pit and capillary vessel patterns of colorectal lesions. MATERIAL At a single institutional referal center during a 36 months period of time, a total of 401 colorectal lesions (classified as polyps, flat, depressed and LST) were evaluated by magnifying zoom imaging associated with virtual chromoendoscopy (FICE) and chromoendoscopy with indigocarmine 0.5%. All lesions were resected endoscopically or surgically. RESULTS In only 2 cases out of 401 lesions the pit and capillary patterns were in disagreement with the histologic findings, resulting in an overall diagnostic accuracy of 99.5%. By endoscopic examination in 375/401 lesions (93.5%) the pit and capillary patterns were in agreement with each other regarding the respective pattern of neoplastic and non neoplastic lesions. In 26 cases (6.5%) out of 401 lesions, the pit pattern differed from the capillary pattern regarding the presumptive histologic nature of the colorectal lesion. In 15/26 cases the pit pattern was IIIL indicating a tubular adenoma and the capillary vessels correctly pointed to a type II pattern which corresponded to the true nature of the lesions composed of hyperplastic globbet cells without glandular serration. CONCLUSIONS: The simultaneous endoscopic classification of the pit and capillary patterns determine a remarkably high accuracy rate in the diagnosis of colorectal lesions obviating the need for conventional histology in the majority of the cases.
S1544 Comparison of Standard Definition White Light (SD-WL), High Definition White Light (HD-WL), and Narrow Band Imaging (NBI) Colonoscopy: Impact on Surveillance Interval Recommendations Neil Gupta, Dayna S. Early, Vikas Singh, Sachin B. Wani, Michael Ansstas, Christine E. Hovis, Srinivas Gaddam, Ajay Bansal, Sreenivasa S. Jonnalagadda, Steven A. Edmundowicz, Prateek Sharma, Amit Rastogi Background: Colonoscopy surveillance intervals are dependent upon the number of adenomas and adenomas with advanced features. The impact of improved adenoma detection by HD-WL and NBI on surveillance interval compared to SDWL is not clear.Aim: To compare SD-WL, HD-WL, and NBI colonoscopy for proportion of patients with 1. 3 or more adenomas2. adenomas ⱖ 1cm3. adenomas with villous features or high grade dysplasia (HGD)and the subsequent impact on surveillance intervals.Methods: Patients referred for screening or surveillance colonoscopy were enrolled and randomized to SD-WL, HD-WL, or NBI colonoscopy at 2 tertiary referral centers (six endoscopists). Following intubation of the cecum, the colonic mucosa was inspected with the
AB190 GASTROINTESTINAL ENDOSCOPY
Volume 71, No. 5 : 2010
16 (7.6%) 22 (10.5%) 9 (4.2%)
28 (13.3%) 23 (10.9%) 6 (2.8%)
28 (13.3%) 26 (12.3%) 10 (4.8%)
0.092 0.855 0.666
30 (14.2%)
38 (18.1%)
41 (19.5%)
0.344
S1545 Utility of Screening Colonoscopy for Average-Risk Individuals Below Age 50 Jue Yong Lee, Sun Pil Choi, Ji Hyeon Nam, Jong Ho Park, Jae Won Shin, Yeon Ho Joo Background and aims: Current guidelines do not recommend screening colonoscopy for colorectal cancer in asymptomatic average-risk individuals below age 50. The aim of the present study was to investigate the prevalence of colorectal neoplasia in the healthy Korean population aged below 50, and to compare it with that above age 50. Methods: A consecutive series of 1831 individuals who underwent screening colonoscopy at Changwon Fatima Hospital as part of their employer provided wellness program between Jan. 2005 and Sept. 2009 were reviewed. Data were obtained from patient charts and electronic medical records. Excluded were those patients with previous history of any malignancy or colorectal adenoma, family history of colorectal cancer and patients having gastrointestinal symptoms. Advanced neoplasia was defined as tubular adenoma measuring 1cm or larger, any villous histology, high grade dysplasia, or cancer. Results: Out of 1,831 patients, 422 (Group A) were between age 30 and 39, 931 (Group B) between age 40 and 49, and 478 (Group C) between age 50 and 59. Nonadvanced adenoma was detected in 201 patients (11.0%); 25 in Group A (5.9%), 95 in Group B (10.2%), and 81 in Group C (16.9%). Advanced neoplasia was detected in 57 patients (3.1%); 8 in Group A (1.9%), 27 in Group B (2.9%), and 22 in Group C (4.6%). The prevalence of advanced neoplasia in group B was not significantly different from that of group C (P ⫽ 0.124). No cancer was detected in Group A, but 1 in Group B (0.11%) and 2 in Group C (0.4%). Carcinoid was found in 2 patients in Group A, and in 1 patient in Group B and C, respectively. All of them were detected in the rectum. Conclusion: The prevalence of both adenoma and advanced neoplasia increases with age. Given that the prevalence of advanced neoplasia in the age group between 40-49 was comparable to that in the age group between 50-59, screening colonoscopy in asymptomatic individuals between age 40-49 may be beneficial. Further study is needed to determine its cost-effectiveness. Finding, n (% of the age group)
Age 30-39
No adenoma Nonadvanced adenoma Advanced neoplasia
389 (92.2%) 25 (5.9%) 8 (1.9%)†
Age 40-49
809 (86.9%) 95 (10.2%) 27 (2.9%, 1 cancer)* Carcinoid 2 (0.5%) 1 (0.1%) * Age 50-59 compared to age 40-49; p⫽0.124 † Age 50-59 compared 39; p⫽0.026
Age 50-59 375 (78.5%) 81 (16.9%) 22 (4.6%, 2 cancers) 1 (0.2%) to age 30-
S1546 High Frequency EUS Miniprobe Staging for Superficial Colorectal Neoplasia: The Utility and Impact on Patients Management Ondrej Urban, Martin Kliment, Petr Fojtik, Premysl Falt Introduction:The treatment of superficial colorectal neoplasias(SCN)is determined by local staging. Mucosal(m)lesions can be treated by the endoscopic musosal resection (EMR) technique and piecemeal resection of larger lesions is
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respective imaging modality. Polyp size, morphology, and location were documented and polyps were removed and submitted for histopathology. The primary outcomes of this study (prevalence of adenomas) are reported separately. Current results were computed by conducting a post hoc analysis using Fisher’s exact test.Results: 630 patients were enrolled (210 in each arm, mean age of 61 years, 65% male, 72% Caucasian, 66% screening colonoscopies). There were no significant differences in gender, race, quality of bowel prep, or number of screening procedures between the 3 groups. Mean age was higher in the HD-WL arm (62 years) compared to SD-WL (60 years) and NBI (60 years) {p⫽0.001}. Mean withdrawal time was higher for NBI (7.5 min) compared to SDWL (6.9 min) and HD-WL (6.6 min) {p⫽0.0002}. The proportion of patients with 3 or more adenomas, an adenoma ⱖ 1cm, an adenoma with villous features or HGD, and impact on future surveillance interval of 3 years are shown in the table. Conclusion: HD-WL and NBI led to changes in surveillance intervals in 4-5% additional patients over SD-WL. While the impact was not statistically significant, the study was not powered for this endpoints. Additional larger studies are needed to investigate the impact of HD-WL and NBI colonoscopy on this clinically important outcome.
S1543 Simultaneous Evaluation of the Pit and Capillary Patterns of Colorectal Lesions on Routine Colonoscopy - Prime Time for Optical Biopsy Claudio R. Teixeira, Ronaldo J. Torresini, Erica Tozawa, Mauro Maia
3 or more adenomas Adenoma ⱖ 1 cm Adenoma with villous or HGD 3 year follow-up
SD-WL (nⴝ210) HD-WL (nⴝ210) NBI (nⴝ210) p value
The endoscopic in vivo observation of microscopic superficial details of colorectal lesions is now possible. The differential diagnosis of small colorectal polyps and characterization of neoplastic lesions is crucial for a better screening colonoscopy and in choosing the right therapy for each colorectal lesion. Kudo et al. have proposed the pit pattern classification of colorectal lesions. Last year, we have developed an original endoscopic classification of the capillary pattern of colorectal lesions and reported its high accuracy rate in the diagnosis of colorectal lesions (GIE 2009). Both pit and capillary classifications include the normal mucosa, hyperplasia, tubular and villous adenoma and carcinoma in a respective scale from I trough V subtypes. Therefore it is easy and practical to simultaneously determine the pit and capillary patterns of lesions diagnosed on colonoscopy. The aim of our study is to compare the histopathologic findings with the simultaneous endoscopic classification of the pit and capillary vessel patterns of colorectal lesions. MATERIAL At a single institutional referal center during a 36 months period of time, a total of 401 colorectal lesions (classified as polyps, flat, depressed and LST) were evaluated by magnifying zoom imaging associated with virtual chromoendoscopy (FICE) and chromoendoscopy with indigocarmine 0.5%. All lesions were resected endoscopically or surgically. RESULTS In only 2 cases out of 401 lesions the pit and capillary patterns were in disagreement with the histologic findings, resulting in an overall diagnostic accuracy of 99.5%. By endoscopic examination in 375/401 lesions (93.5%) the pit and capillary patterns were in agreement with each other regarding the respective pattern of neoplastic and non neoplastic lesions. In 26 cases (6.5%) out of 401 lesions, the pit pattern differed from the capillary pattern regarding the presumptive histologic nature of the colorectal lesion. In 15/26 cases the pit pattern was IIIL indicating a tubular adenoma and the capillary vessels correctly pointed to a type II pattern which corresponded to the true nature of the lesions composed of hyperplastic globbet cells without glandular serration. CONCLUSIONS: The simultaneous endoscopic classification of the pit and capillary patterns determine a remarkably high accuracy rate in the diagnosis of colorectal lesions obviating the need for conventional histology in the majority of the cases.
S1544 Comparison of Standard Definition White Light (SD-WL), High Definition White Light (HD-WL), and Narrow Band Imaging (NBI) Colonoscopy: Impact on Surveillance Interval Recommendations Neil Gupta, Dayna S. Early, Vikas Singh, Sachin B. Wani, Michael Ansstas, Christine E. Hovis, Srinivas Gaddam, Ajay Bansal, Sreenivasa S. Jonnalagadda, Steven A. Edmundowicz, Prateek Sharma, Amit Rastogi Background: Colonoscopy surveillance intervals are dependent upon the number of adenomas and adenomas with advanced features. The impact of improved adenoma detection by HD-WL and NBI on surveillance interval compared to SDWL is not clear.Aim: To compare SD-WL, HD-WL, and NBI colonoscopy for proportion of patients with 1. 3 or more adenomas2. adenomas ⱖ 1cm3. adenomas with villous features or high grade dysplasia (HGD)and the subsequent impact on surveillance intervals.Methods: Patients referred for screening or surveillance colonoscopy were enrolled and randomized to SD-WL, HD-WL, or NBI colonoscopy at 2 tertiary referral centers (six endoscopists). Following intubation of the cecum, the colonic mucosa was inspected with the
AB190 GASTROINTESTINAL ENDOSCOPY
Volume 71, No. 5 : 2010
16 (7.6%) 22 (10.5%) 9 (4.2%)
28 (13.3%) 23 (10.9%) 6 (2.8%)
28 (13.3%) 26 (12.3%) 10 (4.8%)
0.092 0.855 0.666
30 (14.2%)
38 (18.1%)
41 (19.5%)
0.344
S1545 Utility of Screening Colonoscopy for Average-Risk Individuals Below Age 50 Jue Yong Lee, Sun Pil Choi, Ji Hyeon Nam, Jong Ho Park, Jae Won Shin, Yeon Ho Joo Background and aims: Current guidelines do not recommend screening colonoscopy for colorectal cancer in asymptomatic average-risk individuals below age 50. The aim of the present study was to investigate the prevalence of colorectal neoplasia in the healthy Korean population aged below 50, and to compare it with that above age 50. Methods: A consecutive series of 1831 individuals who underwent screening colonoscopy at Changwon Fatima Hospital as part of their employer provided wellness program between Jan. 2005 and Sept. 2009 were reviewed. Data were obtained from patient charts and electronic medical records. Excluded were those patients with previous history of any malignancy or colorectal adenoma, family history of colorectal cancer and patients having gastrointestinal symptoms. Advanced neoplasia was defined as tubular adenoma measuring 1cm or larger, any villous histology, high grade dysplasia, or cancer. Results: Out of 1,831 patients, 422 (Group A) were between age 30 and 39, 931 (Group B) between age 40 and 49, and 478 (Group C) between age 50 and 59. Nonadvanced adenoma was detected in 201 patients (11.0%); 25 in Group A (5.9%), 95 in Group B (10.2%), and 81 in Group C (16.9%). Advanced neoplasia was detected in 57 patients (3.1%); 8 in Group A (1.9%), 27 in Group B (2.9%), and 22 in Group C (4.6%). The prevalence of advanced neoplasia in group B was not significantly different from that of group C (P ⫽ 0.124). No cancer was detected in Group A, but 1 in Group B (0.11%) and 2 in Group C (0.4%). Carcinoid was found in 2 patients in Group A, and in 1 patient in Group B and C, respectively. All of them were detected in the rectum. Conclusion: The prevalence of both adenoma and advanced neoplasia increases with age. Given that the prevalence of advanced neoplasia in the age group between 40-49 was comparable to that in the age group between 50-59, screening colonoscopy in asymptomatic individuals between age 40-49 may be beneficial. Further study is needed to determine its cost-effectiveness. Finding, n (% of the age group)
Age 30-39
No adenoma Nonadvanced adenoma Advanced neoplasia
389 (92.2%) 25 (5.9%) 8 (1.9%)†
Age 40-49
809 (86.9%) 95 (10.2%) 27 (2.9%, 1 cancer)* Carcinoid 2 (0.5%) 1 (0.1%) * Age 50-59 compared to age 40-49; p⫽0.124 † Age 50-59 compared 39; p⫽0.026
Age 50-59 375 (78.5%) 81 (16.9%) 22 (4.6%, 2 cancers) 1 (0.2%) to age 30-
S1546 High Frequency EUS Miniprobe Staging for Superficial Colorectal Neoplasia: The Utility and Impact on Patients Management Ondrej Urban, Martin Kliment, Petr Fojtik, Premysl Falt Introduction:The treatment of superficial colorectal neoplasias(SCN)is determined by local staging. Mucosal(m)lesions can be treated by the endoscopic musosal resection (EMR) technique and piecemeal resection of larger lesions is
www.giejournal.org